11/27/2012

A Population Health Hurricane Sandy?

By David A. Kindig, MD, PhD

I was in New
York City a couple of weeks ago giving several lectures. How strange it was to fly in over
the city lights, cab through a recently flooded tunnel, and find my hotel
without incident. Only after talking to cab drivers and old professional
friends did the impact on so many reveal itself, including major hospitals
still closed, and particularly the many, many stories of how those spared
immediate devastation reached out to those not so fortunate.

At the
beginning of my talks I acknowledged this terrible devastation, but asked if
there could be a silver lining in that finally the greater public and policy
makers will have to confront the realities of climate change in increasingly
frequent extreme weather events. Ideally, this increased attention will lead not
only to short run defensive measures like seawalls but also the more difficult
but critical upstream policies like taxing carbon that will be needed to save
the planet for our grandchildren.

Both natural
and man-made threats can catalyze impressive responses, such as the rapid
expansion in scientific research and training after the Russians launched
Sputnik. With climate change, we might choose to focus all of our efforts on CO2
emissions; unfortunately, there is no similar magic bullet for improving population
health, given the very complex factors that determine health outcomes and health
inequities.

Part of the
problem is that our threats to population health are seldom cataclysmic;
instead, they tend to result in declines in quality of life and economic
productivity over generations. Even the recent finding that a large fraction of
U.S. counties have falling female mortality rates over the past decade doesn’t
seem to rise to policy attention. I am
reminded of the initial work on mortality from hospital errors; the national daily loss was estimated as
equivalent to a Boeing 747 crashing daily. While such a visible loss would have
certainly resulted in policy change, it’s more difficult to generate attention
when it happens quietly and one-at-a-time behind hospital walls.

A year ago, I blogged on Thomas Friedman and Michael Mandelbaum’s That Used to Be Us: How America Fell Behind in the World It Invented
and How We Can Come Back,
which assesses the U.S. position in the world and what needs to be done to
regain lost economic and social competitiveness. They argue that the current
political paralysis is not up to these challenges and that the system calls for
political shock therapy -- a direct analogy to its once classic use in
psychiatry -- defined by the authors as a radical centrist third party.

I observed then that I couldn’t imagine a shock therapy for population
health, but that the following steps were needed over the coming decade.

Identify cross-sectoral national and local partnership models with
business models and financial teeth to leverage additional resources and
policies.

I believe these remain worthy goals, but worry about our slow progress. Is
there a way to induce a cataclysmic call to action without the cataclysm?

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.

Comments

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If worldwide climate change resulting from atmospheric carbon buildup, currently well past the ‘avoidable’ stage and well into the unavoidably serious if not catastrophic stage by the end of this century, is not a cataclysmic call to radically reconsider population health – I don’t know what is. Unfortunately like most population issues climate change will first and most strongly affect the poor (say, the bottom 60%) while the rest will be merely inconvenienced and remain convinced that they have a right to exploit the commons without limitation.